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The Blue Cross and Blue Shield Service Benefit Plan, also known as the BCBS Federal Employee Program® (BCBS FEP®), has been part of the Federal Employees Health Benefits Program (FEHBP) since its inception in 1960. It covers about 5.3 million federal employees, retirees and their families out of the nearly 8 million people who receive their benefits through the FEHBP.

The Blue Cross Blue Shield Association negotiates annually with the U.S. Office of Personnel Management (OPM) to determine the benefits and premiums for the Blue Cross and Blue Shield Service Benefit Plan. The 36 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. Those Plans, including Regence, are responsible for processing claims and providing customer service to our members.

Claims are processed according to the benefits, rules, guidelines and regulations of the federal government, which supersede state laws. Blue Cross and/or Blue Shield Plans offer three coverage options: Basic Option, Standard Option and, effective January 1, 2019, Blue Focus.

Standard Option

Covered medical services include those provided by each local Plan's Preferred and Participating provider networks as well as a reduced benefit for services by a non-participating provider.

  • The highest benefit level is applied when care is received from a Preferred provider.
  • Members are responsible for a calendar year deductible and any applicable office copayments or coinsurance for covered services.
  • When care is received from Preferred or Participating provider, the member is not responsible for any balances over Regence's allowed amount for covered services.

Basic Option

Covered medical services include those provided by the local Plan's Preferred provider network. Members receiving care from primary care providers (PCPs) pay lower copayment amounts than when they receive care from a specialist. Some special exceptions allow benefits to be paid for non-preferred providers.

Standard Option

  • No copayment.
  • The calendar year deductible applies only to the accidental injury benefit.
  • Benefits available only for the preventive/diagnostic and limited basic services listed below.
  • Members can receive services from any provider, but receive a higher benefit when they receive services from a FEP Preferred Provider.
  • OPM has established a fee schedule for covered dental services outlining reimbursement rates for all covered benefits.
  • Member is responsible for the difference between the FEP dental reimbursement schedule amount and the Regence PAR maximum allowable charge when receiving services from a Preferred Provider.
  • When services are received from a non-participating provider, the member is responsible for the difference between the FEP dental reimbursement schedule amount and the actual charges billed.
Note: If a claim is related to an injury, please submit an X-ray of the natural, sound tooth (teeth) before the injury occurred and an X-ray of the injured tooth (teeth).

Basic Option

  • $25 member copayment
  • Benefits available only for the services listed below
  • Members are responsible for all charges when using a non-preferred provider
  • Members must use a FEP Preferred Provider (Regence PAR) to receive benefits
  • OPM has established a fee schedule for covered dental services outlining reimbursement rates for all covered benefits.
  • Preferred dental providers may "balance bill" the patient for the difference between the FEP reimbursement schedule amounts and the Regence PAR allowance.
The following preventive care services are covered:
  • Prophylaxis limited to two per person, per calendar year
  • Oral evaluations limited to two per person, per calendar year
  • Sealant – per tooth, first and second molars only (once per tooth for children up to age 16 only)
  • Topical application of fluoride (child only) limited to two per person, per calendar year; not a benefit for adults
  • Dental X-rays:
    • Bitewings limited to four films per person, per calendar year;
    • Intraoral (complete series including bitewings) limited to one complete series every three years
Services not specifically listed above are not covered.
A $25 copayment should be collected at time of service for oral evaluation procedure codes (CDT D0120, D0140 and D0150). All other preventive dental services are paid in full up to the maximum allowable charge.
Medical plans

Standard Option

Covered medical services include those provided by each local Plan's Preferred and Participating provider networks as well as a reduced benefit for services by a non-participating provider.

  • The highest benefit level is applied when care is received from a Preferred provider.
  • Members are responsible for a calendar year deductible and any applicable office copayments or coinsurance for covered services.
  • When care is received from Preferred or Participating provider, the member is not responsible for any balances over Regence's allowed amount for covered services.

Basic Option

Covered medical services include those provided by the local Plan's Preferred provider network. Members receiving care from primary care providers (PCPs) pay lower copayment amounts than when they receive care from a specialist. Some special exceptions allow benefits to be paid for non-preferred providers.

Standard Option

  • No copayment.
  • The calendar year deductible applies only to the accidental injury benefit.
  • Benefits available only for the preventive/diagnostic and limited basic services listed below.
  • Members can receive services from any provider, but receive a higher benefit when they receive services from a FEP Preferred Provider.
  • OPM has established a fee schedule for covered dental services outlining reimbursement rates for all covered benefits.
  • Member is responsible for the difference between the FEP dental reimbursement schedule amount and the Regence PAR maximum allowable charge when receiving services from a Preferred Provider.
  • When services are received from a non-participating provider, the member is responsible for the difference between the FEP dental reimbursement schedule amount and the actual charges billed.
Note: If a claim is related to an injury, please submit an X-ray of the natural, sound tooth (teeth) before the injury occurred and an X-ray of the injured tooth (teeth).

Basic Option

  • $25 member copayment
  • Benefits available only for the services listed below
  • Members are responsible for all charges when using a non-preferred provider
  • Members must use a FEP Preferred Provider (Regence PAR) to receive benefits
  • OPM has established a fee schedule for covered dental services outlining reimbursement rates for all covered benefits.
  • Preferred dental providers may "balance bill" the patient for the difference between the FEP reimbursement schedule amounts and the Regence PAR allowance.
The following preventive care services are covered:
  • Prophylaxis limited to two per person, per calendar year
  • Oral evaluations limited to two per person, per calendar year
  • Sealant – per tooth, first and second molars only (once per tooth for children up to age 16 only)
  • Topical application of fluoride (child only) limited to two per person, per calendar year; not a benefit for adults
  • Dental X-rays:
    • Bitewings limited to four films per person, per calendar year;
    • Intraoral (complete series including bitewings) limited to one complete series every three years
Services not specifically listed above are not covered.
A $25 copayment should be collected at time of service for oral evaluation procedure codes (CDT D0120, D0140 and D0150). All other preventive dental services are paid in full up to the maximum allowable charge.

Identifying members

All FEP member numbers start with the letter "R", followed by eight numerical digits. Note: On the provider remittance advice, that member number shows as an "8" rather than "R".

The enrollment code on member ID cards indicates the coverage type. View sample member ID cards.

Pre-authorization

Both the Basic and Standard Option Plans require that some services and supplies be pre-authorized. The Blue Focus plan has specific prior approval requirements.

View the lists:

Submit pre-authorization requests via the Availity Provider Portal.
Learn more.

Claims and contact information

Claims for members 65 and older are subject to Medicare pricing.

Prior Plan approval must be obtained for certain services. The pre-service claim approval processes for inpatient hospital admissions (called pre-certification) and for other services (called prior approval), are detailed in the online FEP Benefit Plan Brochure. A pre-service claim is any claim, in whole or in part, that requires approval from us before members receive medical care or services. In other words, a pre-service claim for benefits (1) requires precertification or prior approval and (2) will result in a reduction of benefits if pre-certification or prior approval is not obtained.

Timely claims filing guidelines

  • Participating and Preferred providers: Claims must be submitted within one year from the date of service. Note: If the local Blue Plan's provider contract includes a timely filing provision that is less than FEP's, the local Plan will follow that guideline.
  • Non-participating providers and members: Claims must be submitted no later than December 31 of the calendar year after the year in which the service was rendered (e.g., If the date of service is April 30, 2018, the claim must be submitted by December 31, 2019).

Correspondence - Disputed claims - Medical records requests

If you receive a request for medical records, they can be submitted via the options listed below. Note: The fax option is exclusively for medical records/chart notes that have been requested by FEP (via post claim review) not including requests related to appeals. Please continue to utilize appropriate methods for correspondence that has not been requested.

When submitting medical records via RightFax, the following information should be included:

  • R number
  • Patient name
  • Claim number
  • State (WA, OR, UT, ID) where services were rendered
  • Indicate whether the claim is professional or facility 
  • Provider contact information

Coordination of benefits

FEP members may only have benefits under one FEP plan; however:

  • They may have benefits under a non-FEP plan, in addition to their FEP coverage.
  • If Regence FEP is not the primary insurer, submit claims to the primary insurer first.
  • Please include primary payment information when submitting paper or electronic claims to Regence FEP for secondary payment.

Disputed claims

If the rendering provider disagrees with the payment determination on a claim, they may request a reconsideration. If the claim was denied as a provider write-off, the provider may appeal the decision. Learn more about the Appeals process. Send appeals for FEP claims to:

Regence FEP
P.O. Box 1388
Lewiston, ID 83501-1388

If the claim was denied as member responsibility, the member may request reconsideration as outlined in their Blue Cross and Blue Shield Service Benefit Plan brochure (federal benefits brochure).

  • If the member is still dissatisfied with the outcome, he or she may submit a written appeal to the OPM.
  • Parties acting as a representative for the member, such as medical providers, must include a copy of the member's specific written consent with the review request.
  • This procedure is outlined in detail in the federal benefits brochure.

Contact FEP Provider Customer Service.

Health and wellness

Learn about FEP's Hypertension Management Program and their focus on blood pressure monitor benefit and procedures. Share these informational flyers with your FEP patients: